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Master Thesis

Arrêt cardiaque extrahospitalier : impact du délai de la coronarographie sur la survie

Abstract : Introduction: The optimal timing of coronary angiography and percutaneous coronary intervention in patients successfully resuscitated after out-of-hospital cardiac arrest (OHCA) is still a matter of debate. We aimed to assess the impact of the time interval between OHCA and coronary evaluation (TI) on mortality in patients with no obvious extracardiac cause of arrest. Methods: Between October 2010 and January 2020, 488 patients with OHCA were referred to our tertiary center (Caen University hospital) for a coronary angiogram performed during the first 24 hours. Patients deceased in hospital were compared to survivors. Factors associated with in-hospital and long-term mortality were assessed using a Cox model. Results: Among the 488 patients included, 279 (57.2%) died during hospitalization. At least one significant coronary stenosis was found in 383 (78%) patients with an unstable lesion in 228 (47%) patients, knowing that 199 (41%) presented with ST-segment elevation. The TI was not associated with in-hospital nor longterm mortality in univariate analysis but a short TI was associated with in-hospital mortality in multivariate analysis (HR 0,95 [0,91; 0,99], p=0.03). Older age, increased body mass index, absence of ST-segment elevation and variables of the OHCA score appear as strong predictors of in-hospital mortality while therapeutic hypothermia use was associated with survival. The survivors were able to return to work in 55% of cases but 7.4% remained severely disabled. Conclusion: The TI was not associated with improved survival in patients successfully resuscitated after OHCA suggesting that in the absence of ST-segment elevation or instability such patients should be first evaluated and optimized by dedicated teams and then referred for coronary angiogram in the first 24 hours if deemed necessary.
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Submitted on : Thursday, April 15, 2021 - 2:57:26 PM
Last modification on : Wednesday, November 3, 2021 - 5:06:41 AM
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  • HAL Id : dumas-03199279, version 1


Éric Meimarakis. Arrêt cardiaque extrahospitalier : impact du délai de la coronarographie sur la survie. Médecine humaine et pathologie. 2020. ⟨dumas-03199279⟩



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